Does Diabetes Affect the Surgical Outcomes in Cases With Cervical Ossification of the Posterior Longitudinal Ligament? A Multicenter Study From Asia Pacific Spine Study Group

Study Design: Retrospective multicenter study. Objectives: To evaluate the surgical outcomes of cervical ossification of the posterior longitudinal ligament (OPLL) in diabetes mellitus (DM) patients. Methods: Approximately 253 cervical OPLL patients who underwent surgical decompression with or without fixation were registered at 4 institutions in 3 Asian countries. They were followed up for at least 2 years. Demographics, imaging, and surgical information were collected, and cervical Japanese Orthopaedic Association (JOA) scores and the visual analog scale (VAS) for the neck were used for evaluation. Results: Forty-seven patients had DM, showing higher hypertension and cardiovascular disease prevalence. Although they presented worse preoperative JOA scores than non-DM patients (10.5 ± 3.1 vs. 11.8 ± 3.2; P = 0.01), the former showed comparable neurologic recovery at the final follow-up (13.9 ± 2.9 vs. 14.2 ± 2.6; P = 0.41). No correlation was noted between the hemoglobin A1c level in the DM group and the pre- and postoperative JOA scores. No significant difference was noted in VAS scores between the groups at pre- and postsurgery. Regarding perioperative complications, DM patients presented a higher C5 palsy frequency (14.9% vs. 5.8%; P = 0.04). A similar trend was observed when surgical procedure was limited to laminoplasty. Conclusions: This is the first multicenter Asian study to evaluate the impact of DM on cervical OPLL patients. Surgical results were favorable even in DM cases, regardless of preoperative hemoglobin A1c levels or operative procedures. However, caution is warranted for the occurrence of C5 palsy after surgery.

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Comparison of Laminoplasty and Posterior Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament

10.21203/rs.3.rs-478135/v1 ◽

2021 ◽

Author(s):

Hiroaki Nakashima ◽

Shiro Imagama ◽

Toshitaka Yoshii ◽

Satoru Egawa ◽

Kenichiro Sakai ◽

...

Keyword(s):

Cervical Myelopathy ◽

Perioperative Complications ◽

Clinical Status ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Posterior Fusion ◽

Postoperative Outcomes ◽

Intensity Change ◽

Multivariable Logistic Regression Analysis ◽

Significant Difference

Abstract This prospective multicenter study formed by the Japanese Ministry of Health, Labour and Welfare at 27 institutions aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL). Controversy exists regarding the role of instrumented fusion in the context of posterior surgical decompression for OPLL. Among the 479 patients enrolled, 189 (137 and 52 patients with LM and PF, respectively) were included and evaluated using the Japanese Orthopaedic Association (JOA) scores, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiographical measurements. Basic demographic and radiographical data were reviewed, and the propensity to choose a surgical procedure was calculated. Preoperatively, patient backgrounds, radiographical measurements (K-line or cervical alignment on X-ray, OPLL occupation ratio on computed tomography, and increased signal intensity change on magnetic resonance imaging), or clinical status (JOA score and JOACMEQ) after adjustments showed no significant differences. The overall risk of perioperative complications was lower in LM (odds ratio [OR] 0.40, p = 0.006), and C5 palsy was significantly lower in LM (OR 0.11, p = 0.0002) than in PF. The range of motion (20.91° ± 1.05° and 9.38° ± 1.24°, p < 0.0001) in patients with PF was significantly smaller than in those with LM. However, multivariable logistic regression analysis showed no significant difference in JOA score, JOA recovery rate, or JOACMEQ improvement at two years. In contrast, OPLL progression was greater in LM group than in the PF group (OR 2.73, p = 0.0002). LM and PF for cervical myelopathy due to OPLL resulted in comparable postoperative outcomes at two years after surgery.

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The Impact of Ossification Spread on Cervical Spine Function in Patients With Ossification of The Posterior Longitudinal Ligament

10.21203/rs.3.rs-216266/v1 ◽

2021 ◽

Author(s):

Keiichi Katsumi ◽

Takashi Hirai ◽

Toshitaka Yoshii ◽

Satoshi Maki ◽

Kanji Mori ◽

...

Keyword(s):

Cervical Spine ◽

Multicenter Study ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Multivariate Regression Analysis ◽

Adverse Outcomes ◽

Prospective Multicenter Study ◽

Spine Function ◽

Whole Spine ◽

The Impact

Abstract Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. The bridging of ossified lesions to the vertebral body gradually increases, thereby decreasing the mobility of the cervical spine; thus, cervical spine function may decrease over time. However, cervical spine function in patients with cervical OPLL has not been evaluated in large prospective studies. Therefore, we conducted a prospective multicenter study to clarify whether ossification spread can influence cervical spine function and quality of life (QOL) in patients with cervical OPLL. In total, 238 patients (162 men, 76 women; mean age, 63.9 years) were enrolled from 16 institutions. Each patient underwent whole spine computed tomography and was evaluated cervical spine function and QOL using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). In the multivariate regression analysis, a higher neck VAS score and a larger number of bridge formations of OPLL in the whole spine were significant predictors of adverse outcomes related to cervical spine function. This is the first prospective multicenter study to reveal the impact of ossification spread on cervical spine function. These findings are important to understand the natural course of OPLL and can serve as controls when evaluating postoperative cervical spine function.

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Comparison of laminoplasty and posterior fusion surgery for cervical ossification of posterior longitudinal ligament

Scientific Reports ◽

10.1038/s41598-021-04727-1 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Hiroaki Nakashima ◽

Shiro Imagama ◽

Toshitaka Yoshii ◽

Satoru Egawa ◽

Kenichiro Sakai ◽

...

Keyword(s):

Cervical Myelopathy ◽

Perioperative Complications ◽

Clinical Status ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Posterior Fusion ◽

Postoperative Outcomes ◽

Intensity Change ◽

Multivariable Logistic Regression Analysis ◽

Significant Difference

AbstractThis prospective multicenter study, established by the Japanese Ministry of Health, Labour and Welfare and involving 27 institutions, aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL), in order to address the controversy surrounding the role of instrumented fusion in cases of posterior surgical decompression for OPLL. 478 patients were considered for participation in the study; from among them, 189 (137 and 52 patients with LM and PF, respectively) were included and evaluated using the Japanese Orthopaedic Association (JOA) scores, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiographical measurements. Basic demographic and radiographical data were reviewed, and the propensity to choose a surgical procedure was calculated. Preoperatively, there were no significant differences among the participants in terms of patient backgrounds, radiographical measurements (K-line or cervical alignment on X-ray, OPLL occupation ratio on computed tomography, increased signal intensity change on magnetic resonance imaging), or clinical status (JOA score and JOACMEQ) after adjustments. The overall risk of perioperative complications was found to be lower with LM (odds ratio [OR] 0.40, p = 0.006), and the rate of C5 palsy occurrence was significantly lower with LM (OR 0.11, p = 0.0002) than with PF. The range of motion (20.91° ± 1.05° and 9.38° ± 1.24°, p < 0.0001) in patients who had PF was significantly smaller than in those who had LM. However, multivariable logistic regression analysis showed no significant difference among the participants in JOA score, JOA recovery rate, or JOACMEQ improvement at two years. In contrast, OPLL progression was greater in the LM group than in the PF group (OR 2.73, p = 0.0002). Both LM and PF for cervical myelopathy due to OPLL had resulted in comparable postoperative outcomes at 2 years after surgery.

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The impact of ossification spread on cervical spine function in patients with ossification of the posterior longitudinal ligament

Scientific Reports ◽

10.1038/s41598-021-93602-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Keiichi Katsumi ◽

Takashi Hirai ◽

Toshitaka Yoshii ◽

Satoshi Maki ◽

Kanji Mori ◽

...

Keyword(s):

Cervical Spine ◽

Multicenter Study ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Multivariate Regression Analysis ◽

Adverse Outcomes ◽

Prospective Multicenter Study ◽

Spine Function ◽

Whole Spine ◽

The Impact

AbstractOssification of the posterior longitudinal ligament (OPLL) is a progressive disease. The bridging of ossified lesions to the vertebral body gradually increases, thereby decreasing the mobility of the cervical spine; thus, cervical spine function may decrease over time. However, cervical spine function in patients with cervical OPLL has not been evaluated in large prospective studies. Therefore, we conducted a prospective multicenter study to clarify whether ossification spread can influence cervical spine function and quality of life (QOL) in patients with cervical OPLL. In total, 238 patients (162 men, 76 women; mean age, 63.9 years) were enrolled from 16 institutions. Each patient underwent whole spine computed tomography and was evaluated for cervical spine function and QOL using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). In the multivariate regression analysis, a higher neck VAS score and a larger number of bridge formations of OPLL in the whole spine were significant predictors of adverse outcomes related to cervical spine function. This is the first prospective multicenter study to reveal the impact of ossification spread on cervical spine function. These findings are important to understand the natural course of OPLL and can serve as controls when evaluating postoperative cervical spine function.

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Clinical and Economic Impact of Third-Generation Cephalosporin-Resistant Infection or Colonization Caused by Escherichia coli and Klebsiella pneumoniae: A Multicenter Study in China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17249285 ◽

2020 ◽

Vol 17 (24) ◽

pp. 9285

Author(s):

Xuemei Zhen ◽

Cecilia Stålsby Lundborg ◽

Xueshan Sun ◽

Xiaoqian Hu ◽

Hengjin Dong

Keyword(s):

Escherichia Coli ◽

Klebsiella Pneumoniae ◽

Hospital Mortality ◽

Multicenter Study ◽

Generation Cephalosporin ◽

Total Hospital Cost ◽

Third Generation ◽

E Coli ◽

Significant Difference ◽

The Impact

Quantifying economic and clinical outcomes for interventions could help to reduce third-generation cephalosporin resistance and Escherichia coli or Klebsiella pneumoniae. We aimed to compare the differences in clinical and economic burden between third-generation cephalosporin-resistant E. coli (3GCREC) and third-generation cephalosporin-susceptible E. coli (3GCSEC) cases, and between third-generation cephalosporin-resistant K. pneumoniae (3GCRKP) and third-generation cephalosporin-susceptible K. pneumoniae (3GCSKP) cases. A retrospective and multicenter study was conducted. We collected data from electronic medical records for patients who had clinical samples positive for E. coli or K. pneumoniae isolates during 2013 and 2015. Propensity score matching (PSM) was conducted to minimize the impact of potential confounding variables, including age, sex, insurance, number of diagnoses, Charlson comorbidity index, admission to intensive care unit, surgery, and comorbidities. We also repeated the PSM including length of stay (LOS) before culture. The main indicators included economic costs, LOS and hospital mortality. The proportions of 3GCREC and 3GCRKP in the sampled hospitals were 44.3% and 32.5%, respectively. In the two PSM methods, 1804 pairs and 1521 pairs were generated, and 1815 pairs and 1617 pairs were obtained, respectively. Compared with susceptible cases, those with 3GCREC and 3GCRKP were associated with significantly increased total hospital cost and excess LOS. Inpatients with 3GCRKP were significantly associated with higher hospital mortality compared with 3GCSKP cases, however, there was no significant difference between 3GCREC and 3GCSEC cases. Cost reduction and outcome improvement could be achieved through a preventative approach in terms of both antimicrobial stewardship and preventing the transmission of organisms.

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Outcomes of fusion surgery for ossification of the posterior longitudinal ligament of the thoracic spine: a multicenter retrospective survey

Journal of Neurosurgery Spine ◽

10.3171/2011.6.spine10816 ◽

2011 ◽

Vol 15 (4) ◽

pp. 380-385 ◽

Cited By ~ 50

Author(s):

Morio Matsumoto ◽

Yoshiaki Toyama ◽

Hirotaka Chikuda ◽

Katsushi Takeshita ◽

Tsuyoshi Kato ◽

...

Keyword(s):

Scale Score ◽

Thoracic Spine ◽

Surgical Outcomes ◽

Recovery Rate ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

High Rate ◽

Anterior Decompression ◽

Fusion Surgery ◽

Surgical Methods

Object The aim of this study was to evaluate the outcomes of fusion surgery in patients with ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL) and to identify factors significantly related to surgical outcomes. Methods The study included 76 patients (34 men and 42 women with a mean age of 56.3 years) who underwent fusion surgery for T-OPLL at 7 spine centers during the 5-year period from 2003 to 2007. The authors evaluated the patient demographic data, underlying disease, preoperative comorbidities, history of spinal surgery, radiological findings, surgical methods, surgical outcomes, and complications. Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale score for thoracic myelopathy (11 points) and the recovery rate. Results The mean JOA scale score was 4.6 ± 2.1 points preoperatively and 7.7 ± 2.5 points at the time of the final follow-up examination, yielding a mean recovery rate of 45.4% ± 39.1%. The recovery rates by surgical method were 38.5% ± 37.8% for posterior decompression and fusion, 65.0% ± 35.6% for anterior decompression and fusion via an anterior approach, 28.8% ± 41.2% for anterior decompression via a posterior approach, and 57.5% ± 41.1% for circumferential decompression and fusion. The recovery rate was significantly higher in patients without diabetes mellitus (DM) than in those with DM. One or more complications were experienced by 31 patients (40.8%), including 20 patients with postoperative neurological deterioration, 7 with dural tears, 5 with epidural hematomas, 4 with respiratory complications, and 10 with other complications. Conclusions The outcomes of fusion surgery for T-OPLL were favorable. The absence of DM correlated with better outcomes. However, a high rate of complications was associated with the fusion surgery.

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Surgical Outcomes of Selective Laminectomy for Patients With Cervical Kyphosis: A Retrospective Study of 379 Cases

Global Spine Journal ◽

10.1177/21925682211049799 ◽

2021 ◽

pp. 219256822110497

Author(s):

Ken Ninomiya ◽

Kunimasa Okuyama ◽

Ryoma Aoyama ◽

Satoshi Nori ◽

Junichi Yamane ◽

...

Keyword(s):

Retrospective Study ◽

Roc Curve ◽

Surgical Outcomes ◽

Recovery Rate ◽

Japanese Orthopaedic Association ◽

Curve Analysis ◽

Cervical Kyphosis ◽

Roc Curve Analysis ◽

Spinal Cord Shift ◽

The Impact

Study Design A retrospective study. Objectives This study aimed to investigate the impact of cervical kyphosis on patients with cervical spondylotic myelopathy (CSM) following selective laminectomy (SL) regarding posterior spinal cord shift (PSS), and a number of SLs. Methods We evaluated 379 patients with CSM after SL. The patients with kyphosis (group K) were compared with those without kyphosis (group L). Moreover, groups K and L were divided into subgroups KS and KL (SLs ≤ 2) and LS and LL (SLs ≥ 3), respectively, and analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off value of the C2–C7 angle for satisfactory surgical outcomes, which was defined as a Japanese Orthopaedic Association (JOA) recovery rate of ≥50% in group KS. Results The average PSS (mm) in group K was smaller than that in group L (.8 vs 1.4; P < .01), but the JOA recovery rate was comparable between the 2 groups. Meanwhile, the mean PSS and JOA recovery rate (%) in group KS was lower than those in group KL, respectively (.3 vs 1.0; P < .01, 35.1 vs 52.3; P = .047). Moreover, the average PSS of group KS (.6) was smaller than those of other subgroups ( < .01). In addition, the ROC curve analysis showed that the C2–C7 angle of −14.5° could predict satisfactory surgical outcomes in group KS. Conclusion Selective laminectomy is not contraindicated for patients with kyphosis, but a larger number of SLs may be indicated for the patients with C2–C7 angles of ≤ −14.5°.

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Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes

Global Spine Journal ◽

10.1177/2192568220937473 ◽

2020 ◽

Vol 10 (7) ◽

pp. 896-907

Author(s):

Eric O. Klineberg ◽

Peter G. Passias ◽

Gregory W. Poorman ◽

Cyrus M. Jalai ◽

Abiola Atanda ◽

...

Keyword(s):

Postoperative Complications ◽

Postoperative Complication ◽

Spinal Deformity ◽

Surgical Outcomes ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Complication Rates ◽

Estimated Blood Loss ◽

Patient Reported ◽

The Impact

Study Design: Retrospective review of prospective database. Objective: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes. Methods: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores. Results: Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL ( P < .001) and LOS ( P = .0092). Postoperative complication presence and major postoperative complication were associated with reoperation ( P < .001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores ( P < .02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes ( P < .05). Conclusion: The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes.

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Clinical course of patients with ossification of the posterior longitudinal ligament: a minimum 10-year cohort study

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.100.3.0245 ◽

2004 ◽

Vol 100 (3) ◽

pp. 245-248 ◽

Cited By ~ 37

Author(s):

Shunji Matsunaga ◽

Takashi Sakou ◽

Eiji Taketomi ◽

Setsuro Komiya

Keyword(s):

Cohort Study ◽

Clinical Course ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Cervical Canal ◽

Content Type ◽

Significant Difference ◽

Fine Print

Object. Ossification of the posterior longitudinal ligament (OPLL) may produce quadriplegia. The course of future neurological deterioration in patients with radiographic evidence of OPLL, however, is not known. The authors conducted a long-term follow-up cohort study of more than 10 years to clarify the clinical course of this disease progression. Methods. A total of 450 patients, including 304 managed conservatively and 146 treated by surgery, were enrolled in the study. All patients underwent neurological and radiographical follow-up examinations for a mean of 17.6 years. Myelopathy was graded using Nurick classification and the Japanese Orthopaedic Association scale. Fifty-five (17%) of 323 patients without myelopathy evident at the first examination developed myelopathy during the follow-up period. Risk factors associated with the evolution of myelopathy included greater than 60% OPLL-induced stenotic compromise of the cervical canal, and increased range of motion of the cervical spine. Using Kaplan—Meier analysis, the myelopathy-free rate in patients without first-visit myelopathy was 71% after 30 years. A significant difference in final functional outcome was not observed between nonsurgical and surgical cases in which preoperative Nurick grades were 1 or 2. In patients with Nurick Grade 3 or 4 myelopathy, however, only 12% who underwent surgery eventually became wheelchair bound or bedridden compared with 89% of those managed conservatively. Surgery proved ineffective in the management of patients with Grade 5 disease. Conclusions. Results of this long-term cohort study elucidated the clinical course of OPLL following conservative or surgical management. Surgery proved effective for the management of patients with Nurick Grades 3 and 4 myelopathy.

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Effect of a group medical clinic for veterans with diabetes on body mass index

Chronic Illness ◽

10.1177/1742395317753885 ◽

2018 ◽

Vol 15 (3) ◽

pp. 187-196

Author(s):

Adva Eisenberg ◽

Matthew J Crowley ◽

Cynthia Coffman ◽

David Edelman

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Body Mass Index ◽

Type 2 Diabetes Mellitus ◽

Body Mass ◽

Hemoglobin A1c ◽

Medical Clinic ◽

Significant Difference ◽

The Impact

Objective To assess the impact of a group medical clinic designed for patient with type 2 diabetes mellitus and hypertension on body mass index. Methods Using data from a randomized trial of 239 veterans with type 2 diabetes mellitus, we performed a secondary analysis using analysis of covariance mixed models to explore the effect of a 12-month group medical clinic intervention on change in body mass index vs. usual care. In an exploratory subgroup analysis, we compared change in body mass index between treatment arms stratified by whether patients had >0.5% reduction in hemoglobin A1c at 12 months. Results Baseline body mass index was 33.5 kg/m2. At 12 months, there was no significant difference in change in body mass index between treatment arms (estimate=−0.02, 95% CI −0.51 to 5.05; P = 0.94); body mass index increased by approximately 0.20 points in both groups. There was also no significant difference in change in body mass index between treatment arms by whether or not patients had >0.5% reduction in hemoglobin A1c (estimate=−0.14, 95% CI −1.21 to −0.92; P = 0.79). Discussion Improved glycemic control was not associated with improved body mass index in the group medical clinic intervention. Given their positive effects on other outcomes, group medical clinics for patients with type 2 diabetes mellitus may be more beneficial if focus is shifted towards weight loss.

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